Therapeutic Use Exemptions (TUEs)

Athletes, like all people, may have illnesses or conditions that require them to take a particular medication/substance or undergo certain procedures/methods. If the substance or method appears on WADA’s List of Prohibited Substances and Methods, athletes must obtain a Therapeutic Use Exemption (TUE) in order to have the permission to take it or use it and participate in their sport.
A TUE is a certificate granted by an anti-doping organisation (IF for international-level athletes, NADO for national-level athletes and MEO for athletes participating in an MEO event.). The certificate is for a set prohibited substance, in certain dosages, with a limited period of validity. An application for a TUE must be based on a documented medical condition and diagnosis and the TUE will only be granted under strict criteria laid out in the International standard of TUEs.

Athletes must absolutely avoid taking a medication with a prohibited substance without a valid TUE.

The presence of a prohibited substance or its metabolites or markers in an athlete’s sample without a valid TUE is an Anti-Doping Rule Violation (ADRV), as are the use or attempted use of a prohibited substance or a prohibited method, possession, administration or attempted administration.

Athletes must therefore consult the Prohibited Listwith their prescribing physician before taking a medication to ensure that no prohibited substance is contained in the medication needed.

An International-Level Athlete whose illness or condition requires treatment with a prohibited substance or method must apply to the IF for a TUE following the IF’s strict TUE application process.

Each TUE application will be carefully evaluated by the IF’s Therapeutic Use Exemption Committee and will only be granted in accordance with the and the International Standard for TUEs criteria laid out in article 4 of this standard. If the TUE is granted, the athlete will then be permitted to use the medication during the period of validity of the TUE without committing an Anti-Doping Rules Violation (ADRV).

Regardless of whether a TUE has been granted or not, athletes should always declare on the doping control forms filled out during sample collection any medications and supplements taken within the seven days prior to sample collection, and any blood transfusions in the three months prior for blood samples.

WADA’s role in the TUE process is two-fold. First, the Agency, through its TUEC, has the right to monitor and review any TUE granted by an ADO and, following such review, to reverse any decision. Second, an athlete who submits a TUE application to an ADO (IF or NADO) and is denied a TUE, can ask WADA to review the decision. If WADA determines that denial of the TUE did not comply with the ISTUE, the Agency can reverse the decision. WADA itself does not accept TUE applications from athletes.

National-Level Athletes are to apply to their National Anti-Doping Organisations (NADO) for a TUE – list of NADOs.

WHO MUST OBTAIN TUEs FROM WBSC?
The WBSC Anti-Doping Rules (WBSC ADR) require that all International-level Athletes* who need to take medication/treatment which is on WADA’s Prohibited List must submit a Therapeutic Use Exemption (TUE) application to WBSC as follows:
– If the Athlete does not already have a TUE granted by his/her National Anti-Doping Organisation (NADO), he/she must apply directly to WBSC.
– If the Athlete already has a TUE granted by his/her National Anti-Doping Organisation (NADO), but this NADO is not in the list below**, he/she must apply directly to WBSC.
– If the Athlete already has a TUE granted for national-level competitions by his/her NADO (in the list below**), that TUE is automatically valid for international-level competition and it is not necessary to apply to WBSC for recognition, provided that such TUE decision has been reported in accordance with Article 5.4 of the International Standard for Therapeutic Use Exemptions and therefore is available for review by WADA.
*International-level Athletes: please check the chapter below.
**NADOs with agreement with WBSC and TUE mutual recognition: USA, JPN, KOR, CUB, MEX, TPE, CAN, AUS, NED, PUR, NZL, ARG, CZE, HKG, ITA, GER.

WHICH ATHLETES ARE CONSIDERED TO BE “INTERNATIONAL-LEVEL ATHLETES”?
International-level athletes are defined as:
– Athletes who are part of the WBSC Registered Testing Pool and WBSC Testing Pool;
– Athletes who participate in select WBSC International Events as published by WBSC on its website;Athletes who do not fall under the above-mentioned categories should submit TUE applications to their respective National Anti-Doping Agency (NADO).

HOW INTERNATIONAL-LEVEL ATHLETE APPLY TO WBSC FOR A TUE?
1. As soon as a new treatment is prescribed to you, you must check whether it involves prohibited substances or methods. If this is the case, a TUE application must be submitted.
2. Any TUE request to WBSC has to be submitted through the ADAMS system only (see below). In accordance with the WBSC ADR, TUE applications should be sent at least forty five (45) days before your next competition.
3. TUE applications must be adequately documented with relevant medical records. According to the WBSC ADR, medical evidence confirming the diagnosis and explaining the reasons for the required treatment shall be transmitted along with the TUE application. The medical evidence must include a comprehensive medical history and the results of all relevant examinations, laboratory investigation and imaging studies. Please note that applications sent without medical evidence cannot be considered. Please refer your treating physician to the medical information available on WADA’s website to support the decisions of TUE committees.
4. Once your application is received, WBSC may request additional information in order to document the clinical situation in accordance with WADA’s Standard for Therapeutic Use Exemptions. The WBSC TUE Committee has twenty-one (21) days to issue a decision once the full application (including sufficient medical documentation) is received. For this reason, you should send your TUE application at least 21 days prior to your next competition.
5. If it is not possible for you to apply 45 days before the decision is needed, you must imperatively attest the urgent nature of the application in the form. WBSC tries to be as flexible as possible to accommodate these situations, however urgent applications should be exceptional not routine.
6. TUE applications cannot be considered for retroactive approval except in the cases mentioned in article 4.3 of the International Standard for Therapeutic Use Exemptions.
7. Once a TUE is granted: (1) any change in substance, dosage, route of administration and/or frequency requires the submission of a new TUE application (ISTUE Art. 6.12); and (2) in case of persistence of the medical condition, it is the athlete’s responsibility to apply in advance for renewal of the present TUE prior to its expiry date.
8. Athletes selected for doping control must systematically (i.e. regardless of the presence of a TUE) declare on the doping control form the use of all prescribed and over-the-counter medications as well as supplements taken in the last 7 days.

HOW TO REGISTER ON ADAMS
All International-Level Athletes that need to apply for a TUE have to register on ADAMS:https://adams.wada-ama.org/

WHAT HAPPENS IF A TREATMENT INVOLVES PROHIBITED SUBSTANCES/METHODS AND YOU DO NOT HAVE A TUE?
Using a prohibited substance or method on WADA’s Prohibited List before or without TUE approval will most likely result in an Anti-Doping Rule Violation (ADRV) in the event of an anti-doping test. It is therefore important that athletes check very carefully whether any treatment they are prescribed involves prohibited substances or methods. Athlete should also not assume that all medical professionals who prescribe medication have a full understanding of anti-doping-related matters in their sport. Athletes are advised to treat the matter of TUEs seriously and in all instances seek expert advice.

NUTRITIONAL SUPPLEMENTS
Extreme caution is recommended regarding supplement use. A significant number of positive tests have been attributed to the misuse or contamination of supplements and poor labeling of dietary supplements.